Dissociation can be described as feeling disconnected from the self, the world, or reality. Someone experiencing dissociation may not remember what happens during the episode. They might also feel as if they are observing themselves from an outside perspective.
Many people begin dissociating while experiencing abuse or another traumatic event. Dissociation can help people cope with what’s happening, but if it continues after the trauma stops, it can negatively affect a person’s life.
There are several types of dissociation, though they share some common features. According to Mental Health America, about a third of people experience dissociation on occasion. About 4% of people have more frequent or severe dissociation.
People who dissociate might:
- Seem distracted, not fully present
- “Space out” while talking or working
- Do things on autopilot
- Seem dreamy or move slowly
- Say or do out-of-character things
- Have gaps in their memories or sense of time
Dissociative identity (DID) is perhaps the most well-known dissociative condition. It occurs in about 1.5% of the population, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
People with DID have more than one identity state. These different identities, often called alters, can take control of the person’s thoughts and behavior, often during times of trauma or stress. The person may not remember what happens when an alter is in control.
As with other types of dissociation, DID can develop in response to trauma. It’s often linked to ongoing trauma in childhood.
What Does Dissociation Feel Like?
Mild dissociation is common. Most people daydream or lose track of time on occasion. Even briefly seeing familiar surroundings as strange or unrecognizable isn’t unusual. If these feelings happen often, last for a long time, or cause distress, it may be a good idea to talk to a counselor.
How dissociation feels may vary based on the type of dissociation and the person who has it. There are three main types of dissociation: dissociative identity, dissociative amnesia, and depersonalization-derealization. The DSM also lists other specified dissociative disorder and unspecified dissociative disorder.
People with dissociative identity might:
- Feel like they’re more than one person
- Feel more than one other “self” within their thoughts
- Take on other identifies that have different memories, mannerisms, or speech patterns
- Lose memories or periods of time. Lost time may relate to switching between identities (alters)
- Have flashbacks, nightmares, or sleep issues
- Have panic attacks
- Have depression, anxiety, or other mental health conditions
DID can cause distress and emotional strain. People with DID also have an increased risk for self-harm and suicidal thoughts. They may feel powerless to maintain their identity, afraid of what their alter states might do while in control, and frustrated with their inability to remember events.
Dissociative amnesia is memory loss associated with trauma. People may:
- Lose memories of the traumatic event or time period
- Lose only memories of a certain part of an event or time period
- Lose memories of a specific person
- Be unable to remember new events
- Be unable to remember anything about themselves or use learned skills
- Have memory gaps or flashbacks
- Have difficulty forming relationships
- Experience confusion or distress
- Have trouble sleeping
Dissociative fugue, a rare form of dissociative amnesia, can indicate DID. It occurs when a person has a period of memory loss and takes on a new identity away from home. The person may not regain memories and identity for some time.
Depersonalization-derealization disorder (DDD) is characterized by a sense of detachment from reality. People with this condition may:
- See things and people as foggy or dreamlike
- Feel that time is moving too fast or too slow
- Feel like their actions aren’t their own. Events may seem like they’re from a movie.
- Feel like their surroundings aren’t real, while being aware that they are real
People often seem unconcerned, detached, or disoriented during episodes. But because people with DDD remain aware of reality while feeling disconnected from it, the condition often causes significant distress.
5 Triggers for Dissociation
Dissociative depression, a type of chronic depression, tends to develop earlier than other types of depression, sometimes as early as childhood. It’s been linked to trauma and post-traumatic anger. People may have more somatic symptoms, like pain, and are at increased risk for suicidal thoughts. They may experience mood swings, difficulty concentrating, and weight fluctuation more frequently than people with other types of depression.
Research suggests this type of depression is most common in women who experienced childhood sexual abuse. It’s often treatment-resistant—until dissociative symptoms are treated. Then the depression typically improves.
Borderline personality (BPD)
Some characteristics of dissociation are similar to those of borderline personality. For example, an alter identity may be seen as an unstable sense of self. Self-harm, suicidal ideation, and difficulty managing emotions when stressed are associated with both dissociative issues and BPD. People with BPD also often struggle in relationships and avoid difficult experiences, and many hear voices. BPD is also commonly linked to childhood trauma and neglect.
Seventy-five to eighty percent of people with BPD may experience dissociation during stress. In fact, dissociation is one of nine diagnostic criteria for BPD (five are needed for diagnosis). According to a 2016 analysis of 10 studies, dissociation occurs more often with BPD than with other mental health issues.
Recent research suggests dissociation may affect memory and emotional learning, which may be one reason why BPD is often difficult to treat.
Research has linked addictive behaviors and dissociation. A 2005 study found that more than 17% of people getting help for substance abuse had a form of dissociation. Addiction, which can be seen as a type of dissociative behavior, has further been linked to trauma and alexithymia, a condition where people can’t identify their emotions. A study published in 2014 suggested trauma, alexithymia, and dissociation could often predict alcohol dependence. Like dissociation, addiction to alcohol may develop in response to trauma.
A 2015 study looking at 68 people who were substance-free for at least six months found that almost 25% had severe depersonalization symptoms, while over 40% experienced mild depersonalization. The study did not determine a cause of the symptoms, but the findings suggest a further link between addiction and dissociative symptoms.
Obsessive-compulsive disorder (OCD)
Multiple studies have found links between dissociation and OCD. Dissociative symptoms occur often with OCD. People with OCD might have dissociative episodes without having a specific dissociative condition. OCD symptoms can resemble dissociative symptoms, especially when the person experiences distress related to their thoughts or compulsions. People trying to resist intrusive thoughts, for example, may push them away by making themselves experience memory loss (forcible amnesia).
When people have both conditions, dissociative symptoms tend to be more severe. The risk for depression also increases, as does the risk for a co-occuring personality disorder.
Attention-deficit hyperactivity (ADHD)
ADHD is often misdiagnosed. Research suggests some children thought to have ADHD may in fact be showing signs of trauma. Telling the two conditions apart can be difficult. Blanking out while remembering something frightening, having difficulty focusing, and acting out are all signs of both posttraumatic stress and ADHD. A small 2006 study found that children who experienced abuse were more likely to show apparent symptoms of ADHD but actually have a dissociative condition.
Many children exposed to repeated trauma or abuse go on to develop a dissociative condition.
Though they may still have ADHD, it’s often not be the primary cause of symptoms. Mental health professionals may find it helpful to evaluate for posttraumatic stress as well as ADHD and ask the children they work with about home and school.
A study published in 2017 further linked ADHD and dissociation. According to the study, people with BPD are more likely to have a history of childhood trauma, dissociation, and ADHD symptoms.
Does the Cause of Dissociation Influence How It’s Treated?
Therapy is the primary treatment for dissociation. Medication might be recommended when severe symptoms of depression or anxiety accompany dissociation, but there is no medication that treats dissociation itself. If another mental health issue occurs with dissociation, effective treatment should consider both concerns.
People with borderline personality, ADHD, depression, substance abuse issues, or OCD can also benefit from therapy, but the most helpful types of therapy vary.
Dialectical behavior therapy is considered the most effective therapy for BPD, but some research suggests dissociation may negatively impact the success of DBT. People who have both conditions may respond better to treatment that focuses on dissociative symptoms. Treatment that focuses on managing BPD symptoms may not help dissociative symptoms. Research shows it’s important to address the underlying trauma as well.
Dissociative depression is often resistant to treatment when dissociation symptoms aren’t addressed, so it’s important for mental health professionals to be able to recognize dissociative issues in therapy. If chronic depression is treated with antidepressants, people with dissociative depression may see little improvement. But treating the dissociation often helps improve depression.
One study suggested screening people with substance abuse issues for dissociative symptoms, in order to treat both issues. Dissociation symptoms in people with addiction could persist if only addiction is treated.
Dissociative symptoms often go unrecognized in therapy, especially when the person seeking support has another mental health condition. Dissociation is treatable, but it’s important for therapists to recognize and address symptoms when they occur with other mental health conditions. Treatment may have less benefit when the person seeking help is dissociating, as they may not be as “present” in therapy.
When seeking help, tell a therapist about all symptoms, even if they don’t seem connected. Therapy is most effective if you can discuss all symptoms and begin to work through underlying trauma.
Remember you are not alone! Help is available. Begin your search for a counselor today.
- American Psychiatric Association. (2018). What are dissociative disorders? Retrieved from https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
- Craparo, G., Ardino, V., Gori, A., & Caretti, V. (2014). The relationships between early trauma, dissociation, and alexithymia in alcohol addiction. Psychiatry Investigation, 11(3), 330-335. doi: 10.4306/pi.2014.11.3.330
- Dissociative disorders. (2017, November 17). Retrieved from https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/diagnosis-treatment/drc-20355221
- Endo, T. (2006). Attention-deficit/hyperactivity disorder and dissociative disorder among abused children. Psychiatry and Clinical Neurosciences, 60(4), 434-438. doi: 10.1111/j.1440-1819.2006.01528.x
- Foster, C. (2016). Understanding dissociative disorders. Retrieved from https://www.mind.org.uk/media/4778451/understanding-dissociative-disorders-2016.pdf
- Goff, D. C., Olin, J. A., Jenike, M. A., Baer, L., & Buttolph, M. L. (1992). Dissociative symptoms in patients with obsessive-compulsive disorder. The Journal of Nervous and Mental Disease, 180(5), 332-337. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1583477
- Kleindienst, N., Limberger, M. F., Ebner-Priemer, U. W., Keibel-Mauchnik. J., Dyer, A., Berger, M., Schmahl, C., & Bohus, M. (2011). Dissociation predicts poor response to dialectical behavior therapy in female patients with borderline personality disorder. Journal of Personality Disorders, 25(3), 432-447. doi: 10.1521/pedi.2011.25.4.432
- Krause-Utz, A., & Elzinga, B. (2018). Current understanding of the neural mechanisms of dissociation in borderline personality disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. Retrieved from https://link.springer.com/article/10.1007%2Fs40473-018-0146-9
- Kulacaogu, F., Solmaz, M., Ardic, F. C., Akin, E., & Kose, S. (2017, September 30). The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD. Psychiatry and Clinical Psychopharmacology, 27(4), 393-402. Retrieved from https://www.tandfonline.com/doi/full/10.1080/24750573.2017.1380347
- Mosquera, D., & Steele, K. (2017). Complex trauma, dissociation and borderline personality disorder: Working with integration failures. European Journal of Trauma and Dissociation, 1(1), 63-71. Retrieved from https://www.sciencedirect.com/science/article/pii/S2468749917300145
- Ruiz, R. (2014, July 7). How childhood trauma could be mistaken for ADHD. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/07/how-childhood-trauma-could-be-mistaken-for-adhd/373328
- Saddichha, S., Pradhan, N., Gupta, H. (2011). A case of obsessive-compulsive disorder presenting as dissociative disorder: The role of sodium thiopental interview. The Primary Care Companion for CNS Disorders, 13(3). doi: 10.4088/PCC.10l01134
- Sar, V. (2015). Dissociative depression is resistant to treatment-as-usual. Journal of Psychology and Clinical Psychiatry, 3(2). Retrieved from https://pdfs.semanticscholar.org/2e1f/54678c76ed2071655c9378ce60c56d4abfc1.pdf
- Sar, V. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171-179. doi: 10.9758/cpn.2014.12.3.171
- Scalabrini, A., Cavicchiolo, M., Fossati, A., & Maffei, C. (2016, November 21). The extent of dissociation in borderline personality disorder: A meta-analytic review. Journal of Trauma and Dissociation, 18(4), 522-543. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15299732.2016.1240738
- Schafer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M. D., Chodzinski, C. … Driessen, M. (2010, June 1). Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study. Drug and Alcohol Dependence, 109(1-3), 84-89. doi: 10.1016/j.drugalcdep.2009.12.012
- Sirvent, C., & Fernandez, L. (2015, May 11). Depersonalization disorder in former addicts (Prevalence of depersonalization-derealization disorder in former addicts). Journal of Addiction Research & Therapy, 6. Retrieved from https://www.omicsonline.org/open-access/depersonalization-disorder-in-former-addicts-prevalence-of-depersonalizationderealization-disorder-in-former-addicts-2155-6105-1000225.php?aid=52845
- Spiegel, D. (2017). Dissociative amnesia. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/dissociative-disorders/dissociative-amnesia
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